The use of diagnostic radiology has been dramatically increasing for many years with proportional financial and patient safety effects. Between 2000 and 2007 the use of imaging studies grew faster than that of any other physician service in the Medicare population. Currently, there are more than 70 million CT scans performed in the United States every year. A study by the influential group America's Health Insurance Plans claims that 20% to 50% of all “high-tech” imaging provides no useful information and may be unnecessary, and the radiation exposure from these scans may lead to thousands of cancer-related deaths. Reports like these have led to cost and safety concerns among key federal agencies like the Congressional Budget Office, Government Accountability Office, and Medicare Payment Advisory Commission, and steps have been taken in recent years to reduce reimbursements for imaging as one means of reducing overall usage and exposure.
The overuse of diagnostic radiology is partially explained by the fact that it has been enormously helpful in the areas of non-invasive diagnosis. Some conditions that previously required general surgery to diagnose can now be painlessly and quickly found with a CT Scan, with much less inherent risk to the patient. The diagnostic radiology field is also responsible for saving many patients' lives by facilitating the timely diagnosis of dangerous medical conditions, such as internal bleeding. As a result of these obvious benefits of diagnostic radiology, the risks inherent in its use are often overlooked. Ionizing radiation, which is a component of much (but not all) diagnostic radiology, carries with it a small risk of inducing cancer every time it is used. This additional risk is known as “Lifetime Attributable Risk” or “LAR”. The LAR due to medical imaging is layered on top of an individual's lifetime base risk of invasive cancer, which is approximately 37% for women and 45% for men.
The LAR due to diagnostic radiology has historically been assumed to be relatively low, and usually less than 1%, but a sub-group of individuals in society exists with a much higher LAR. This sub-group represents approximately 2% of the population as found in the large study population used to develop the Rads Scoring system. Although this group of individuals is numerically small, they account for 25% of all the CT Scans in the study group. This finding conforms with the general understanding that the top 1% of medical users consume about 20% of the resources and the top 5% consume nearly 50%. In the case of radiology overuse, the top 2% of patient consumers are also absorbing much of the additional cancer risk for the population. In many cases, this additional cancer risk approaches 10% and in rare cases, the additional risk approaches 20%.
The above begs the question, if radiology overuse is an accepted problem that results in financial waste and patient risk with often times little benefit, why does it continue? There are several possible answers. Firstly, medico-legal concerns amongst providers are generally accepted to be a source of defensive medicine practice patterns with resultant overuse of diagnostics of all types, including radiology. Secondly, patient satisfaction leads many institutions down the path of giving patients what they want, be it x-rays, antibiotics, or pain medications. The Federal Government's incorporation of patient satisfaction into reimbursement equations creates direct financial incentives to make patients happy, even when it may not be in their overall best interest. Thirdly, hidden or difficult-to-get-to information leads to repeat diagnostics when it becomes easier to order it again rather than find and access previous results. Lastly, there are many times a provider will order a test without knowledge of recent testing that may have otherwise dissuaded them from ordering additional tests.
There are of course many more possible reasons behind the overuse of diagnostic radiology, but a common thread emerges in the above. Our current healthcare system provides many more reasons to order a radiologic test as compared with reasons to not order a radiologic test. At least one component of the solution to the problem of radiology overuse must therefore involve the creation of a reason (or reasons) not to order radiological tests. Some of these reasons could be (a) increasing awareness of previous testing, (b) increasing awareness of additional radiation risk exposure for the patient, (c) instituting checks and balances when ordering additional studies for high risk patients, (d) exposure to financial risk for inappropriate ordering, and (e) medico-legal exposure for unnecessary testing that impacts patient safety.
One additional problem with radiology overuse is that even when it is suspected, many providers lack the ability to properly contextualize the amount of overuse and apply it to a risk/benefit analysis. Therefore, clinical decisions are often made without a true understanding of accumulated risk. In a similar vein, discussions with patients about radiology overuse are often lacking in content and relevancy, or worse, contaminated with misinformation. Therefore, an additional component of any solution must be the creation of relevant and contextual information for a provider and patient to consider. In order for this information to be relevant and contextual, it must relate to identifiable, “down to earth”, quantities and concepts.
The present method, system, and computer program product for determining a patient Radiation and Diagnostic Study Score provides right time, right place, and right format radiology information to providers to assist them in their medical decision-making. With greater awareness of recent study history, and individually contextualized risk and benefit considerations, providers are more likely to decrease their overall usage of diagnostic radiology, and also be enabled to better counsel their patients on future risk.